Zingiber officinale rhizome and roots (copyright E. Yarnell)
Abstract
The evidence that Zingiber officinale (ginger) is anticoagulant is mostly based on in vitro work. Human clinical trials generally do not support that it is a significant inhibitor of clotting or platelets. Similarly, the majority of clinical trials do not support that it does not interact with anticoagulant or antiplatelet drugs in any clinically concerning manner.
Does Ginger Inhibit Platelets?
At least 8 clinical trials have been done on this question (see table below for details). The studies have used multiple different ginger products and doses, and have come to quite variable conclusions. There were no reported clinical instances of bleeding in any of the trials. Though the AlAksar, et al. 2020 trial reported that a 4 g of ginger powder dissolved in hot water decreased platelet aggregation in one assay (using added epinephrine ex vivo) compared to baseline, the higher dose (4 g bid) had no such effect. This result is almost entirely because of chance. Four other ex vivo methods of assessing platelet aggregation showed no effect from either dose of ginger powder tea.
Reference | Trial type | Patient population | Dose, form, duration | Results |
AlAksar, et al. 2020 | Open randomized trial | n=40 healthy Arab adults | Dried ginger 4 g qd vs. 4 g bid as powder in tea | No effect on platelet count or platelet aggregation (4 g qd dose showed increased aggregation on a single measure) |
Young, et al. 2006 | Open crossover trial | n=10 healthy Chinese adults | Dried ginger 1 g qd x 7 d | No effect on platelet aggregation |
Young, et al. 2006 | Open crossover trial | n=10 hypertensive Chinese adults | Dried ginger 1 g qd x 7 d | No effect on platelet aggregation |
Jiang, et al. 2005 | Open crossover trial | n=6 Asian and 6 white healthy men | Dried ginger 1.2 g tid x 14 d | No effect on platelet aggregation |
Bordia, et al. 1997 | Open clinical trial | n=60 Indian adults w/ history of MI | Dried ginger, 4 g qd x 3 mon | No effect on platelet aggregation vs. placebo |
Bordia, et al. 1997 | Open clinical trial | n=20 Indian adults w/ history of MI | Dried ginger, 10 g single dose | Platelet aggregation decreased ~75% vs. placebo |
Janssen, et al. 1996 | Open randomized crossover clinical trial | n=18 healthy Dutch adults | Fresh ginger 15 g qd, cooked ginger 40 g qd, or custard alone, all in vanilla custard 125 g x 14 d | No effect on platelet thromboxane A2 production by either dose form vs. placebo |
Lumb 1994 | Randomized, double-blind trial | n=8 healthy white men | Dried ginger 2 g single dose | No effect on platelet count, platelet aggregation, or bleeding time vs. placebo |
Verma, et al. 1993 | Open randomized trial | n=20 healthy Indian men eating 100 g butter, 8 slices bread, 2 cups of milk per day | Dried ginger 2.5 g bid x 7 d | Elevated platelet aggregation caused by diet was reduced back close to baseline with ginger, significant vs. placebo |
Srivastava 1989 | Open trial | n=7 healthy Danish women | Fresh ginger 5 g qd x 7 d | Platelet thromboxane A2 production reduced 37% vs. baseline |
Studies are in order from most recent to oldest.
Any concern about ginger causing bleeding must explain the results of a clinical trial in 92 Iranian women with menorrhagia in which 250 mg of dried ginger daily significantly reduced bleeding compared to placebo over three menstrual cycles (Kashefi, et al. 2015).
Does Ginger Interact with Anticoagulant or Antiplatelet Drugs?
There are some limited human trials with ginger and various anticoagulant and antiplatelet drugs, summarized in the table below. There were no clinical instances of bleeding in any of the trials.
Reference | Drug combination | Trial type | Patient population | Dose, form, duration | Results |
Young, et al. 2006 | Nifedipine 10 mg bid x 7 d | Open crossover trial | n=10 healthy Chinese adults | Dried ginger 1 g qd x 7 d | Platelet aggregation inhibition ~tripled vs. nifedipine alone |
Young, et al. 2006 | Nifedipine 10 mg bid x 7 d | Open crossover trial | n=10 hypertensive Chinese adults | Dried ginger 1 g qd x 7 d | Platelet aggregation inhibition ~tripled vs. nifedipine alone |
Jiang, et al. 2005 | Warfarin 25 mg (single dose) | Open crossover trial | n=6 Asian and 6 white healthy men | Dried ginger 1.2 g tid x 14 d | No interaction |
Studies are in order alphabetically by drug, and then from most recent first to oldest.
No human trials were identified concerning ginger and any other anticoagulant or antiplatelet drug beyond the very items from the table above. One preclinical study found that an ethanol extract of ginger at a dose of 500 mg/kg protected rats against gastric ulcers induced by indomethacin and aspirin, with no mention of any bleeding problems (al-Yahya, et al. 1989).
References
al-Yahya MA, Rafatullah S, Mossa JS, et al. (1989) "Gastroprotective activity of ginger Zingiber officinale Rosc, in albino rats" Am J Chin Med 17(1–2):51–6.
AlAskar A, Shaheen NA, Khan AH, et al. (2020) "Effect of daily ginger consumption on platelet aggregation" J Herbal Med 20:100316.
Bordia A, Verma SK, Srivastava KC (1997) "Effect of ginger (Zingiber officinale Rosc) and fenugreek (Trigonella foenum-graceum L) on blood lipids, blood sugar, and platelet aggregation in patients with coronary artery disease" Prostagland Leukotrienes Essential Fatty Acids 56:379–84.
Janssen PLTMK, Meyboom S, van Staveren WA, et al. (1996) "Consumption of ginger (Zingiber officinale Roscoe) does not affect ex vivo platelet thromboxane production in humans" Eur J Clin Nutr 50(11):772–4.
Jiang XM, Williams KM, Liauw WS, et al. (2005) “Effect of ginkgo and ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects” Br J Clin Pharmacol 59(4):425–32.
Kashefi F, Khajehei M, Alavinia M, et al. (2015) “Effect of ginger (Zingiber officinale) on heavy menstrual bleeding: A placebo-controlled, randomized clinical trial” Phytother Res 29(1):114–9.
Lumb AB (1994) "Effect of dried ginger on human platelet function" Thromb Haemost 7(1):110–1.
Srivastava KC (1989) "Effect of onion and ginger consumption on platelet thromboxane production in humans" Prostaglandins Leukotr Essent Fatty Acids 35(3):183–5.
Verma SK, Singh J, Khamesra R, Bordia A (1993) "Effect of ginger on platelet aggregation in man" Indian J Med Res 98:240–2.
Young HY, Liao JC, Chang YS, et al. (2006) “Synergistic effect of ginger and nifedipine on human platelet aggregation: A study in hypertensive patients and normal volunteers” Am J Chin Med 34(4):545–51.
AlAskar A, Shaheen NA, Khan AH, et al. (2020) "Effect of daily ginger consumption on platelet aggregation" J Herbal Med 20:100316.
Bordia A, Verma SK, Srivastava KC (1997) "Effect of ginger (Zingiber officinale Rosc) and fenugreek (Trigonella foenum-graceum L) on blood lipids, blood sugar, and platelet aggregation in patients with coronary artery disease" Prostagland Leukotrienes Essential Fatty Acids 56:379–84.
Janssen PLTMK, Meyboom S, van Staveren WA, et al. (1996) "Consumption of ginger (Zingiber officinale Roscoe) does not affect ex vivo platelet thromboxane production in humans" Eur J Clin Nutr 50(11):772–4.
Jiang XM, Williams KM, Liauw WS, et al. (2005) “Effect of ginkgo and ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects” Br J Clin Pharmacol 59(4):425–32.
Kashefi F, Khajehei M, Alavinia M, et al. (2015) “Effect of ginger (Zingiber officinale) on heavy menstrual bleeding: A placebo-controlled, randomized clinical trial” Phytother Res 29(1):114–9.
Lumb AB (1994) "Effect of dried ginger on human platelet function" Thromb Haemost 7(1):110–1.
Srivastava KC (1989) "Effect of onion and ginger consumption on platelet thromboxane production in humans" Prostaglandins Leukotr Essent Fatty Acids 35(3):183–5.
Verma SK, Singh J, Khamesra R, Bordia A (1993) "Effect of ginger on platelet aggregation in man" Indian J Med Res 98:240–2.
Young HY, Liao JC, Chang YS, et al. (2006) “Synergistic effect of ginger and nifedipine on human platelet aggregation: A study in hypertensive patients and normal volunteers” Am J Chin Med 34(4):545–51.